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Bruderer-Hofstetter M.1,2, Rausch Osthoff A.-K.1, Koehler B.1, Niedermann Schneider K.1
1Zurich University of Applied Sciences / Institute of Physiotherapy, Health, Winterthur, Switzerland, 2University of Lucerne, Faculty of Humanities and Social Sciences, Lucerne, Switzerland
Background: Performance on (instrumental) activities of daily living ((I)ADL) is related to appropriate physical health and cognitive function. Both, physical exercises and cognitive training may improve several aspects of physical capacity and cognitive function and recent reviews pointed out that combined interventions most effectively improved cognition in the elderly. However, it remains uncertain whether the effects on physical capacity and cognitive function translate into improvement of (I)ADL performance.
Purpose: The purpose was to systematically review the evidence of multi-component interventions in improving physical capacity and cognitive function in community-dwelling elderly people with/without mild cognitive impairment (MCI) and to investigate whether improvements in physical capacity and cognitive function translate into (I)ADL performance.
Methods: A systematic literature review was conducted on randomised controlled trials (RCTs) comparing the effects of multi-component interventions with no or any other active intervention on physical capacity, cognitive function and (I)ADL performance in community dwelling elderly persons (age ≥ 55 years) with/without MCI. We searched PubMed, PsycINFO, CINAHL, Scopus and CENTRAL. The results were supplemented through hand search. Two reviewers independently screened potentially included papers, extracted key data and assessed the quality of the included studies and the overall quality of evidence. A narrative synthesis of the results was performed.
Results: 26 papers (8 with/18 without MCI), including 1962 participants (age 55 97) met our inclusion criteria. Interventions lasted 1 - 3 sessions/week for 8 - 26 weeks, between 20 - 90 minutes/session. Thirteen studies investigated the effects of combined physical training and dual-task exercises on physical capacity (muscle strength, cardiorespiratory fitness, balance, physical function and walking abilities), global cognition and specific cognitive domains (executive function, memory, attention, speed) with inconsistent findings on all outcomes. Three studies investigated the effects of physical exercises plus cognitive training on physical capacity (cardiorespiratory fitness), global cognition, specific cognitive domains (executive function, memory, attention) and (I)ADL performance with inconsistent findings on all outcomes. Two studies investigated the effects of exergames on specific cognitive domains (executive function, attention, speed) and physical function with inconsistent findings on all outcomes. Two studies investigated the effects of music-based training: one study on global cognition (improvement) and walking abilities (no improvement) the second study on physical functions (no improvement). Five studies investigated the effects from Tai Chi, Yoga or Karate and one study the effects of physical training plus Tai Chi on physical capacity (muscle strength, dual task performance, walking abilities), global cognition, specific cognitive domains (executive function, attention) with inconsistent findings and one study on (I)ADL performance (no improvement).
Conclusion(s): Multi-component interventions may improve physical capacity and cognitive function depending on the training regimen but the associations between (I)ADL performance, physical capacity and cognitive function are still not well understood.
Implications: Further investigations are needed to better understand physical capacity and cognitive function as determinants of (I)ADL performance and their association. This will be a promising base for the development of a multi-component intervention that aims to target maintenance of independence in (I)ADL in elderly with/without MCI.
Funding acknowledgements: The project was unfunded.
Topic: Older people
Ethics approval: Ethics approval was not required.
All authors, affiliations and abstracts have been published as submitted.
